Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

There probably isn't a whole lot left to say about this case -- although I promise you a lot more will be said as more information comes out and we go down the road of years of criminal and civil litigation. But I haven't seen anyone comment on the sheer immensity of the destruction that one man could wreak. This is important, in fact, to our interpretation of history.

Obviously we have to begin with his most direct victims, the boys who he exploited for his gratification. We will never know how many there were, but the police have intimated that they are aware of somewhere north of 20. I'm sure it's many more than that.

But consider: he established a charitable organization, and helped it raise millions of dollars, for the purpose of providing himself with a continual supply of vulnerable children, fully documented with all of the information he needed to make his selections and work his methods. He even kept annotated lists of boys, provided by the organization, in his desk at home, evidently to guide his choices. Sandusky used and betrayed all of the donors and volunteers associated with the Second Mile as callously as he used the boys. The staff of the Second Mile now find themselves out of work and I can't imagine their job searches are going well. How are you going to apply for a job as an executive or director of development for a charitable organization when the last thing on your resume is the Second Mile? Good luck with that. And no, as far as any publicly available information is concerned, they had no idea.

Now consider Penn State football. Not that I particularly care about it, but thousands of young men went through the program and it meant a lot to them. They were proud of it. Linebacker Lavar Arrington has already come forward to express how betrayed he feels, and I'm sure he's just speaking for the entirety. Presumably Sandusky wasn't figuring on getting caught but he had to know it was possible.

So now we come to University. Many people have gotten up on their high horse and proclaimed that PSU needs to cough up the tens or hundreds of millions it's going to take to settle with the victims without any quibbling in order to restore the honor of the university. But PSU did not perpetrate these crimes, nor did PSU cover them up. Specific people did that -- namely Graham Spanier, Tim Curley, and Gary Schultz, and apparently Joe Paterno, based on CNN's second-hand reporting about e-mails they haven't actually seen. Okay, Paterno is dead and the other three are out of work, with at least two of them and probably all three facing prosecution. There are important lessons about the judgments they made and what it all means, which I will not belabor.

However, Penn State is not the football team, and it is not these four men. It is a major university with a mission of research and teaching. Those hundreds of millions of dollars aren't going to come out of the football program, they're going to come out of student aid, instruction, and scholarship. Where else?

I can believe that free will is an illusion and still call this man indescribably, immeasurably evil. Unfortunately that does not make him unique. But he happened to be a football coach at Penn State, instead of Ohio State; or perhaps a professor at Harvard, or an executive of the Boys and Girls Club of America, or a United States senator or the Prime Minister of England. You name it. The actions of individuals can have enormous repercussions beyond their immediate reach. Obviously that goes for the single moral choice made by Graham Spanier as well as the decades-long campaign of horror waged by Jerry Sandusky. Our lives, and everything we value, are always balancing on a knife edge. Try to do the right thing.